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DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Atlanta. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 6 select care drugs through standard pharmacies or standard mail order. For Tier 1 preferred generics, standard costs are an $18 copay for a one-month supply, while Tier 2 generics require a $19 copay for a one-month supply. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 33% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, home health care, and preventive services. For inpatient hospital stays, members pay a $450 copay for the first few days and no copay for subsequent days, while emergency room visits carry a $115 copay that is waived if admitted. Outpatient services and diagnostic tests are highly affordable, ranging from no copay to a maximum $550 copay depending on the service, with no coinsurance required. This plan also includes strong specialty benefits, such as dental care with no copay up to a $2,500 annual limit and a $300 annual allowance for eyewear with no copay. Routine hearing exams require a $40 copay, while prescription hearing aids are covered with copays between $399 and $699. Additionally, members benefit from a quarterly $50 over-the-counter allowance with no copay and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) with no coinsurance, featuring a $450 copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services range from no copay to a $550.00 copay, observation services require a $450.00 copay per stay, and outpatient substance abuse sessions have a $40.00 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) plan with a $70.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers ambulance services with prior authorization, requiring a copay of $0 to $315 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $40 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays of $115 for emergency or urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Other primary care benefits, including specialist, therapy, and mental health services, are covered with copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. While weight management and nutritional benefits are included, several additional services like in-home support, counseling, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers routine hearing exams with a $40 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $399 to $699 and no coinsurance, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) offers partially covered vision services, including one annual routine eye exam with a copay of $0 to $40, no deductible, and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no deductible, no copay, and no coinsurance up to a $300 annual limit for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) partially covers dental services up to a $2,500 annual maximum for both in- and out-of-network care, offering Medicare-covered dental services for a $40 copay and no coinsurance. Other covered preventive and comprehensive services have no copay and no coinsurance, though other diagnostic services, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, incur no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) with no copay for all covered items, though diabetic therapeutic shoes and inserts are not covered. Durable medical equipment carries a 20% coinsurance, while covered prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) covers diagnostic and radiological services, with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) plan with no copay, no coinsurance, and a prior authorization requirement. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP) are partially covered, offering no copay and no coinsurance for over-the-counter items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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